Healthcare Provider Details

I. General information

NPI: 1659506228
Provider Name (Legal Business Name): CRANBERRY COUNSELING PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2009
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 WINTER ST STE 303
WEYMOUTH MA
02188-3336
US

IV. Provider business mailing address

210 WINTER ST STE 303
WEYMOUTH MA
02188-3336
US

V. Phone/Fax

Practice location:
  • Phone: 781-837-5344
  • Fax: 781-803-2728
Mailing address:
  • Phone: 781-837-5344
  • Fax: 781-803-2728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3821
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: TERRY ALAN HAYES
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 781-837-5344